Provider Demographics
NPI:1558992644
Name:ESTEP, JAMES KENT
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KENT
Last Name:ESTEP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 DALLAS HWY SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1675
Mailing Address - Country:US
Mailing Address - Phone:770-425-0552
Mailing Address - Fax:770-425-6104
Practice Address - Street 1:3600 DALLAS HWY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1675
Practice Address - Country:US
Practice Address - Phone:770-425-0552
Practice Address - Fax:770-425-6104
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0160791835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist